Healthcare Provider Details

I. General information

NPI: 1932375979
Provider Name (Legal Business Name): MAYEMURA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 W MCGRAW ST
SEATTLE WA
98199-3208
US

IV. Provider business mailing address

3202 W MCGRAW ST
SEATTLE WA
98199-3208
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-5850
  • Fax: 206-600-5850
Mailing address:
  • Phone: 206-284-5850
  • Fax: 206-600-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA BURDEN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 206-284-5850